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Provider Relations-Networking-Contracting WellCare - Provider Relations, Networking, & Contracting Leadership Careers

Provider Relations - Director Job

Full Job Title: Director Provider Relations

Job Number: 1804538

Location: Statewide, NC

Date Posted: 2018-06-20

Strategizes for optimal business practices and efficiencies with an emphasis on producing revenue for the corporation. Position plans, provides resources and directs activities in network development, provider contracting/negotiation and provider service functions.

Essential Functions:
  • Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded.
  • Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
  • Plans, conducts and directs provider contracting/negotiations and provider servicing.
  • Develops practices to assist risk partners in managing financial risk.
  • Performs data analysis and develops specific actions to manage medical cost trends.
  • Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions.
  • Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources.
  • Strategizes for membership growth, retention, and to affect sophisticated or complex provider relationships.
  • Maintains compliance for State and CMS audits.
  • Special projects as assigned or directed.

This position is contingent upon the bid award in the state of North Carolina to WellCare Health Plans, Inc.

    Candidate Education:
    • Required A Bachelor's Degree in a related field or equivalent work experience directly related to the level and duties of the job
    Candidate Experience:
    • Required 7 years of experience in provider relations or similar background
    • Required 4 years of experience in management
    Candidate Skills:
    • Intermediate Demonstrated leadership skills
    • Intermediate Ability to lead/manage others
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Ability to influence internal and external constituents
    • Advanced Demonstrated analytical skills
    • Advanced Other Facilitative skills
    • Intermediate Other Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace
    • Intermediate Other Ability to convert related activities into a comprehensive work plan
    • Advanced Other Financial skills
    • Advanced Other Knowledge of CMS and state regulations
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Excel

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        Last Updated On: 12/9/2015